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The U.S. Supreme Court has upheld a decision whereby closely-held companies can request exemptions the Patient Protection and Affordable Care Act (ACA) coverage provision for some contraceptives because of the corporations' founding family's religious beliefs.

Hobby Lobby and Conestoga Wood Specialities both refused to provide employee converge for four of the 20 contraceptive methods approved by the FDA, specifically those that they perceive as preventing uterine implantation of a fertilized egg, such as emergency hormonal contraceptives and intrauterine devices (almost entirely incorrect scientifically).

Hobby Lobby is a nationwide arts-and-crafts chain founded by David and Barbara Green, devout Christians, and their three sons. Also included in the Hobby Lobby decision is the biblical bookstore chain, Mardel, led by one of the Green's sons.

Conestoga was founded by devout Mennonite, Norman Hahn, and is owned an managed with his wife and three sons. Conestoga's board of directors adopted a Statement on the Sanctity of Life that holds "life begins at conception."

The Court ruled that the companies are permitted the latitude for coverage exemption under the Religious Freedom Restoration Act of 1993. The Act aims to prevent laws the substantially burden a person's exercise of their religious beliefs.

For example, the RFRA allowed the Court to rule that a New Mexico sect of a religious organization could use the hallucinogenic plant mixture ayahuasca because it was central to their religious practice. On the other hand, the Court ruled against two Native American worshippers in Oregon who lost their jobs and unemployment coverage because they used peyote in religious ceremonies.

Should the religious beliefs of corporate leadership apply?

Much of the controversy over today's decision derives from the fact that Hobby Lobby and Conestoga are not in the business of conducting religious services or overseas humanitarian missions as their primary business. They are for-profit companies. The ruling allows the corporations to refuse coverage because of the religious beliefs of individual leaders.

I've been concerned about this point since pharmacist organizations allow for the conscientious objection of individual pharmacists who refuse to fill prescriptions for emergency contraception. Would pharmacists have the right to exercise their conscience in refusing to fill prescriptions for other drugs that their religion opposes?

In the dissenting opinion, Justice Ginsburg wrote more extensively for the minority,

"Would the exemption the Court holds RFRA demands for employers with religiously grounded objections to the use of certain contraceptives extend to employers with religiously grounded objections to blood transfusions (Jehovah's Witnesses); antidepressants (Scientologists); medications derived from pigs, including anesthesia, intravenous fluids, and pills coated with gelatin (some Muslims, Jews, and Hindus); and vaccinations (Christian Scientists, among others)?"

"According to counsel for Hobby Lobby, "each one of these cases . . . would have to be evaluated on its own . . . apply[ing] the compelling interest-least restrictive alternative test." Not much help there for the lower courts bound by today's decision."

The majority opinion held that no such cases have come before the court, therefore, such challenges should not be expected. But Justice Ginsburg wrote for the minority that religious objections to immunization programs, for example, are not merely hypothetical.

Just this year, a Brooklyn Federal District Court Judge denied a religious challenge to New York's "social distancing" provision of their childhood immunization school laws that requires those not vaccinated for a vaccine-preventable illness to stay home during declared disease outbreaks (Phillips v. New York).

Ginsburg also cited a brief from Liberty Counsel suggesting that clients can object on religious grounds to any vaccine whose production may have involved abortive fetal tissue, even if using an immortalized cell line established from a fetal decades ago.

An offense to public health

The American Public Health Association has already come out decrying today's ruling, stating they are "saddened" and "dismayed."

"The ruling contradicts widely accepted medical care standards, which ensure that women are not denied access by employers to the full range of critical preventive health care services..."

"...By limiting the contraceptive coverage clause, the Supreme Court placed the interest of a corporation ahead of the health of women. APHA and the public health community strongly oppose today’s ruling."